By David Blumenthal, MD, MPP, President, The Commonwealth Fund, and Tanya Shah, MBA, MPH, Assistant Vice President, Delivery System Reform, The Commonwealth Fund
The dialogue on caring for patients with complex needs has moved beyond a recognition that social factors like housing or nutrition have an outsize impact on health to practicalities. Now, health care providers are asking: what can we actually do to help?
Increasingly, providers are partnering with public health departments, social service agencies, and nonprofits to connect patients to services such as legal aid, food banks, and transportation. Research has documented that efforts to integrate health and social services can improve health outcomes.
However, most partnerships are modest in scale and temporary, often funded through limited grants or launched as short-term pilot programs. Health care organizations have not made “social determinant interventions” part of their business operations. And for their part, community-based organizations that provide social services have limited funds to invest in infrastructure or in tracking outcomes. Without formal financial relationships that recognize and reward the value generated by community organizations, sustaining partnerships to address patients’ social needs will be an ongoing challenge.
The Better Care Playbook features two resources that can foster and sustain partnerships between health care providers and their community partners. A report by KPMG’s Government Institute provides a framework based on lessons from the field and expert interviews on how to develop a business case for addressing patients’ nonmedical needs. It guides health care organizations on how to identify populations, choose interventions, and measure their impact.
And the ROI Calculator for Partnerships to Address the Social Determinants of Health assists health care organizations and their community partners in creating mutually beneficial financial arrangements to fund the delivery of social services to complex patients. The premise of the calculator is that risk and reward should and can be shared between partners. It calculates the return on investment (ROI) from integrating social services with medical care and shows how the financial returns and risks could be divided among partners under a variety of payment arrangements (e.g., fee-for-service, capitation, or gain-sharing). It can be used to inform programmatic planning and negotiations between partners, as well as to measure the impact of particular interventions.
Currently, users must enter in their own estimates of the population to be served, the costs of services, and their likely impact on health care utilization. In the calculator’s next iteration, we will provide parameters from the literature and use cases to guide users on how social services can help generate financial returns.
Sharp HealthCare, a large nonprofit health system in Southern California, is using the ROI calculator to explore the business case for expansion of the Care Transitions Intervention (CTI), which seeks to ensure that patients’ medical and nonmedical needs are met after hospital discharge. As part of the program, Sharp is partnering with 2-1-1 San Diego, a nonprofit that connects patients to resources such as healthy food, stable housing, and transportation. Calculating the ROI of providing such social services will help Sharp decide whether to expand the program and whether to create comparable partnerships in the future.
Our hope is that these tools will promote sustainable, effective cross-sector partnerships that yield returns in terms of better health, better quality of life, and more efficient healthcare.